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. 2018 Apr;118(7):1005-1012.
doi: 10.1038/s41416-018-0007-z. Epub 2018 Mar 9.

Tobacco, alcohol use and risk of hepatocellular carcinoma and intrahepatic cholangiocarcinoma: The Liver Cancer Pooling Project

Jessica L Petrick  1 , Peter T Campbell  2 , Jill Koshiol  3 , Jake E Thistle  3 , Gabriella Andreotti  3 , Laura E Beane-Freeman  3 , Julie E Buring  4   5 , Andrew T Chan  5   6   7 , Dawn Q Chong  8 , Michele M Doody  3 , Susan M Gapstur  2 , John Michael Gaziano  4   9 , Edward Giovannucci  10 , Barry I Graubard  3 , I-Min Lee  4   10 , Linda M Liao  3 , Martha S Linet  3 , Julie R Palmer  11 , Jenny N Poynter  12 , Mark P Purdue  3 , Kim Robien  13 , Lynn Rosenberg  11 , Catherine Schairer  3 , Howard D Sesso  4   10 , Rashmi Sinha  3 , Meir J Stampfer  5   10   14 , Marcia Stefanick  15 , Jean Wactawski-Wende  16 , Xuehong Zhang  5 , Anne Zeleniuch-Jacquotte  17 , Neal D Freedman  3 , Katherine A McGlynn  3
Affiliations

Tobacco, alcohol use and risk of hepatocellular carcinoma and intrahepatic cholangiocarcinoma: The Liver Cancer Pooling Project

Jessica L Petrick et al. Br J Cancer. 2018 Apr.

Abstract

Background: While tobacco and alcohol are established risk factors for hepatocellular carcinoma (HCC), the most common type of primary liver cancer, it is unknown whether they also increase the risk of intrahepatic cholangiocarcinoma (ICC). Thus, we examined the association between tobacco and alcohol use by primary liver cancer type.

Methods: The Liver Cancer Pooling Project is a consortium of 14 US-based prospective cohort studies that includes data from 1,518,741 individuals (HCC n = 1423, ICC n = 410). Multivariable-adjusted hazards ratios (HRs) and 95% confidence intervals (CI) were estimated using proportional hazards regression.

Results: Current smokers at baseline had an increased risk of HCC (hazard ratio (HR) = 1.86, 95% confidence interval (CI): 1.57-2.20) and ICC (HR = 1.47, 95% CI: 1.07-2.02). Among individuals who quit smoking >30 years ago, HCC risk was almost equivalent to never smokers (HR = 1.09, 95% CI: 0.74-1.61). Compared to non-drinkers, heavy alcohol consumption was associated with an 87% increased HCC risk (HR≥7 drinks/day = 1.87, 95% CI: 1.41-2.47) and a 68% increased ICC risk (HR≥5 drinks/day = 1.68, 95% CI: 0.99-2.86). However, light-to-moderate alcohol consumption of <3 drinks/day appeared to be inversely associated with HCC risk (HR>0-<0.5 drinks/day = 0.77, 95% CI: 0.67-0.89; HR>0.5-<1 drinks/day = 0.57, 95% CI: 0.44-0.73; HR1-<3 drinks/day = 0.71, 95% CI: 0.58-0.87), but not ICC.

Conclusions: These findings suggest that, in this relatively healthy population, smoking cessation and light-to-moderate drinking may reduce the risk of HCC.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Cubic spline graph of the multivariate-adjusted HRs (represented by the solid line) and 95% CIs (represented by the dotted lines) for the association between smoking intensity and a HCC and b ICC in the Liver Cancer Pooling Project (knots: 0.5, 10, 15, 25; referent: 0)
Fig. 2
Fig. 2
Cubic spline graph of the multivariate-adjusted HRs (represented by the solid line) and 95% CIs (represented by the dotted lines) for the association between drinks per day of alcohol and a HCC (knots: 1, 3, 5, and 7; referent: 0.25) and b ICC (knots: 1, 3, and 5; referent: 0.25) in the Liver Cancer Pooling Project
See this image and copyright information in PMC

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